Do you have hand pain after punching a wall? It could be a boxers fracture. Boxers fractures are very common hand injuries. The typical cause is striking a hard surface with a clenched fist – such as punching a wall. These injuries can also occur in contact sports, automobile collisions, altercations, or falling to the ground on an outstretched hand. 

A boxer’s fracture specifically is a fracture of the fifth metacarpal neck. The hand has five metacarpals, one for each finger and the thumb. The metacarpals make up the bony architecture of the hand between the wrist and the fingers. The fifth metacarpal is at the base of the small finger, or pinkie. The metacarpal neck is the part of the bone between the head and shaft of the metacarpal, closest to the MCP “knuckle” joint. 

The most common signs of a boxer’s fracture are pain, bruising, swelling, limited finger range of motion, grip weakness, and deformity. The knuckle can look out of place or missing. The finger can also look deformed or crooked. If these symptoms do not go away within a brief period of observation, patients should be evaluated by a medical professional. 

Treatment of boxers fracture

Early treatment for a boxer’s fracture includes resting the hand, immobilization, ice, elevation, and oral anti-inflammatory medications to relieve pain, swelling, and inflammation. Most patients do not require expensive medical treatment or surgery in order to achieve a good functional result. Several studies have shown that most patients benefit from simple treatment and can expect good long-term hand function. However, patients should be advised that there may be a cosmetic difference between the injured and uninjured hands. 

Patients with these injuries may benefit from specialized orthopedic care. This treatment includes x-ray evaluation, custom splinting, and hand therapy. Traditionally, many patients have been treated with closed reduction and casting of fifth metacarpal fractures. This involves the use of a local anesthesia injection and manipulation of the fracture site to improve the x-ray alignment. Recent studies have shown us that this procedure may not provide any long-term benefit to patients with mild-to-moderate severity fractures.

In most cases, treatment consists of activity modifications and using a removable splint for 3-6 weeks. As patients heal, they are guided to increase their hand activity within their pain tolerance and progress through a series of range of motion and hand strengthening exercises. Hand therapy is available to help patients regain their pre-injury hand function more quickly. Most patients typically regain normal hand function about 2-3 months following this injury. 

Occasionally surgery is recommended for patients with a boxer’s fracture. If there is significant angulation at the fracture site or if the finger is malrotated, surgery can be helpful to realign and stabilize the fractured bone. Complications from surgery include infection, stiffness, scar tissue formation, and possibly the need for additional surgery such as the removal of implants or scar tissue.    

A word of caution: not all fifth metacarpal fractures are boxer’s fractures. Inexperienced clinicians often mislabel a fifth metacarpal shaft fracture as a “boxer’s fracture.” Fractures involving the shaft of the metacarpal can result in significant hand impairment if not treated adequately. Consider consultation with an orthopedic hand specialist to guide your hand care appropriately.

The Raleigh Hand to Shoulder Center physicians have treated patients with hand and upper extremity problems for three decades. From a minor cut to a severe hand injury, we have been specialty-trained to diagnose, treat, and rehabilitate patients with a variety of hand and arm problems. The hand is one of the most intricate and delicate areas of the human body, comprised of nineteen bones in addition to joints, tendons, muscles, nerves, and blood vessels. As you know, our hands are critical for independent function and livelihood. An alteration in the normal function of the hand can significantly impact a person’s life. T

Raleigh Hand to Shoulder Center doctors are all members of the American Society for Surgery of the Hand and are board-certified by the ABOS.

Osteoarthritis is one of the most common ailments affecting the hands. Wear and tear arthritis within the joints can lead to weakness, deformity, limited range of motion, inflammation, and pain. These symptoms can impair the function of the hand and reduce a person’s quality of life. Conventional medical treatments for hand osteoarthritis in the United States include oral anti-inflammatory medications (NSAIDs), oral acetaminophen, topical medications, splints, hand therapy, and corticosteroid injections. Opioid medications are prescribed less frequently for this condition due to the concern for adverse effects, addiction, and overdose. Surgery can also reduce the symptoms, but this is considered a last-resort option for many people. 

Side effects and adverse reactions from conventional osteoarthritis medications are well-known.  Due to the limitations of these treatments, many people have turned toward alternative options. These include dietary changes, oral supplements such as glucosamine, chondroitin, and turmeric, and topical cannabidiol (CBD) products.

Cannabidiol (CBD) products became widely available in the United States after the passage of the Agriculture Improvement Act in 2018, known as the Farm Bill. This bill legally differentiated hemp from marijuana. Marijuana and hemp are closely related plants in the cannabis family. Industrial hemp is now defined as cannabis with less than 0.3% THC, the psychoactive component of marijuana. Marijuana is defined as cannabis with  greater than 0.3% THC. Although several US states have legalized the recreational use of marijuana, the federal Drug Enforcement Agency considers marijuana a controlled substance with a high potential for abuse.

CBD is one of the many cannabinoid compounds found within the cannabis plant. CBD is thought to have antioxidant, anti-inflammatory, and analgesic (pain-relieving) effects in the body. CBD does not have the psychoactive effects of THC. CBD products derived from licensed hemp growers can be legally purchased over-the-counter in most US states, including North Carolina. CBD is available in many product forms including oral and topical (absorbed through the skin) application.

A recent article in the Journal of Hand Surgery evaluated the safety and efficacy of topical CBD for treatment of thumb basal joint arthritis.  In this study, half of the patients were treated with 2 weeks of topical CBD cream and the other half were treated with a topical placebo. This was a randomized, controlled trial in which the patients did not know whether they were using the CBD cream or the placebo cream. The patients using the CBD cream reported significantly less pain than the control group, noting a 60% reduction in pain on average. There were no adverse events reported. The study concluded that “twice-daily topical CBD application resulted in improvements in thumb basal joint arthritis-related pain and disability without adverse events.” Additional studies are needed to confirm these results and to determine the safety and efficacy of topical CBD in longer term use.  

Many CBD products on the market today do not meet the US Food and Drug Administration (FDA) quality standards. It is unknown which brand or concentration of CBD is preferred. Third-party, independent company testing is available to confirm the purity and quality of CBD products. The FDA is also concerned about potential health effects of CBD treatment including liver toxicity, drug interactions, and fertility issues.  The FDA has not approved the marketing of CBD for treatment of osteoarthritis. 

All current osteoarthritis remedies are aimed at treating the symptoms of arthritis. They do not change the underlying degenerative joint disease process. In 2022, there is still no known “cure” for osteoarthritis. Manufacturers may promise miraculous results, but many medical claims are unproven. Consumers should be skeptical of unrealistic expectations. 

Based on recent research, the results appear to be encouraging for short term use of topical CBD products for hand osteoarthritis symptoms. However, the FDA has not approved the marketing of CBD for treatment of osteoarthritis.  More studies are required to determine the safety and efficacy of these products.

Several Raleigh Hand to Shoulder Center hand surgeons have been named top doctors in 2023. Congratulations to the doctors!

Capital City Surgery Center has been named the best ambulatory surgery center in North Carolina for several years in a row! Raleigh Hand to Shoulder Center doctors perform the majority of their outpatient surgeries at Capital City Surgery Center. The doctors are partners in the center.

The scaphoid, one of eight small bones in the wrist, is most commonly injured due to a fall on an outstretched wrist.  It occurs most frequently in young men in their teens to 30’s.  A patient with a scaphoid fracture (broken scaphoid bone) will have pain on the radial (thumb) side of their wrist.  They will often have pain with wrist range of motion and may also have decreased movement of the wrist. Occasionally the injury is not obvious, and patients may think the injury “is only a wrist sprain.”

If a scaphoid fracture is suspected, X-rays should be obtained.  However, X-rays will sometimes fail to reveal the crack in the bone if it is small, and thus additional tests such as MRI or CT scans may be ordered.

Scaphoid Fracture Treatment

If you have a scaphoid fracture, treatment is usually a cast or surgery.  Scaphoid fractures heal slowly due to their limited blood flow.  It may take several weeks or months in a cast before the fracture heals, depending on the type of fracture.  Surgery is recommended for certain types of scaphoid fractures and in some patient groups.   In several studies, the healing rates are better and faster with surgery versus cast treatment.  Surgery can often be done through a percutaneous or minimally invasive approach, but does have some possible complications and surgical risks. 

When a scaphoid fracture is not treated, the bone may not heal, and patients often experience worsening wrist pain, decreased range of motion, and stiffness.  In time, these patients may develop wrist arthritis and may require surgical treatment in the future.

Raleigh Hand to Shoulder Center doctors are all board-certified by the ABOS and are members of the ASSH. Raleigh Hand to Shoulder center doctors treat patients from Raleigh, Durham, Chapel Hill, Cary, Morrisville, Apex, Knightdale, and Wake Forest, NC.

Dupuytrens contracture is a common disease of the hand. This condition is known for increased fibrous tissue formation in the palms of the hands and in the fingers. Early in the course of the disease process, nodules of fibrous tissue develop in the palm. In some patients these nodules develop into cords which gradually bend the fingers into a flexed position. Over time, the finger joints become stiff and more difficult to straighten. This is called a flexion contracture. Severe contractures in the fingers can develop which significantly impair the use of the hand. Patients often have problems putting on gloves and shaking hands. Dupuytrens contracture treatment is available in Raleigh, NC. 

Doctors have known about Dupuytren’s disease for many centuries. The condition is named after Dr. Dupuytren who was a French surgeon in the 1800s.  The condition has also been called “Viking’s disease” because it is more common in people with Scandinavian ancestry. Research has increased over the past several decades. However, there is still much to be learned about Dupuytren’s. 

Risk factors for Dupuytrens Contracture

Risk factors for Dupuytren’s disease include male sex, family history of the condition, Northern European ancestry, smoking, alcohol abuse, and diabetes. People with Dupuytren’s disease are also prone to plantar fibromatosis (Lederhosen), penile fibrosis (Peyronies), and adhesive capsulitis (frozen shoulder). 

Treatment options for Dupuytrens Contracture

Treatment options are available for Dupuytren’s disease at various stages of the disease process. Currently, there are no cures for Dupuytren’s and no proven way to slow down the disease process. Corticosteroid injections (cortisone shots) are sometimes used to reduce pain, itching, or discomfort from Dupuytren’s nodules in the palm. Steroid injections can shrink and soften the nodules in most patients, however, the nodules often come back in the future. Radiation treatment is considered controversial for Dupuytren’s disease.

When a joint contracture has developed from a Dupuytren’s cord, there are two non-surgical treatments for Dupuytren’s contracture: needle aponeurotomy and collagenase injections. Both procedures can be performed in the office. These procedures can significantly improve finger range of motion and patients have a much quicker recovery compared to surgery. Patient satisfaction is usually high for these procedures. Not all patients are candidates for these procedures. If patients are treated in the mild to moderate stages of contracture, the results are usually good to excellent and frequently last many years.

Needle Aponeurotomy for Dupuytrens Contracture

Needle Aponeurotomy (NA) is a minimally-invasive procedure performed with local anesthesia numbing medicine in the office. The Dupuytren’s cord is perforated with a needle tip. NA is particularly useful when the primary contracture is in the palm or when a patient cannot have surgery due to medical problems. Recurrence is common with this technique, but it is a simple and inexpensive technique that can give some relief for a few years and may be repeated for recurrent contractures. Not all patients are candidates for this technique and complications include skin tears, infection, and nerve injury.

Collagenase for Dupuytrens Contracture

Collagenase injections (Xiaflex) were FDA approved for use in the United States in 2010.  The collagenase enzyme injection is used to help dissolve Dupuytren’s cords. The injection is performed in the office and the cord is manually “popped” by the surgeon in 1 or 2 days. Although the period of time before a contracture recurs is unpredictable, recurrence of the contracture is common following collagenase injections. Not all patients are good candidates for this injection. Possible complications from collagenase injections include: tendon ruptures, skin tears, bruising, allergic reactions, and lymph node swelling. 

Dupuytrens Contracture Surgery

Dupuytrens Surgery is the tried-and-true treatment for Dupuytren’s contractures in the fingers. Surgery can be performed safely in the operating room to improve finger range of motion and quality of life when patients are not candidates for the non-surgical options. This surgery is performed in the operating room under a regional block anesthetic as an outpatient. This procedure often provides good to excellent results in patients with mild to moderate joint contractures. Patients will be treated with splinting, wound care, and hand therapy for a few weeks during the recovery process after surgery. Make an appointment with a hand specialist to learn about Dupuytren’s and the treatment options recommended for your case.

Raleigh Hand to Shoulder Doctors are experts in diagnosis and treatment of Dupuytrens contracture. They are all members of the American Society for Surgery of the Hand and board certified by the American Board of Orthopedic Surgery.

Raleigh Hand to Shoulder Center doctors are specialists in carpal tunnel syndrome, among many other conditions of the hand and arm. They are doctors for carpal tunnel syndrome and many other hand problems. Carpal tunnel syndrome (CTS) is a type of pinched nerve in the wrist. It is the most common compression neuropathy in the hand and arm. It results from increased pressure on the median nerve at the wrist, within the carpal tunnel. Symptoms such as hand numbness, tingling, weakness, and pain can result if the nerve is compressed or “pinched.” Patients often wake up at night with their hand numb, tingling, and in pain.

What is carpal tunnel?

The carpal tunnel is a passageway in the wrist which contain the median nerve and flexor tendons. The carpal tunnel is a narrow space made up by the bones of the wrist and the transverse carpal ligament. The median nerve is at risk for compression within this tunnel. If there is swelling, abnormal wrist anatomy, or injury to this area, the function of the median nerve may be affected.

What are treatments for carpal tunnel syndrome?

Treatment can include a wrist brace during sleep, hand therapy, steroid injection, and surgery if conservative treatment is not successful. Surgery is usually recommended if there are signs of severe carpal tunnel syndrome or nerve damage. Treatment for carpal tunnel syndrome can alleviate numbness and tingling in the hand at night and improve hand function during the day.

Doctors for Carpal Tunnel Syndrome

Raleigh Hand to Shoulder Center doctors are members of the American Society for Surgery of the Hand and are Board certified by the American Board of Orthopedic Surgery. Speak to a hand surgeon about your condition to discover treatment options to relieve your symptoms.

A wrist fracture is a common wrist injury. This type of injury can occur from a variety of trauma, such as a fall at home or a motor vehicle collision. The distal radius is the portion of the radius bone just below the wrist joint. As we age, the bone of the distal radius loses bone mass and becomes more prone to fracture, particularly in post-menopausal women and people with osteoporosis. The distal radius may break (also called a “fracture”) as a result of a slip and fall in these cases. Younger patients with stronger bones may break the distal radius after high-energy trauma, such as a sports injury or car accident. Broken wrist treatment involves specialized orthopedic care, and proper healing is needed to obtain the best outcome. Wrist fracture treatment is available in Raleigh from the experts in hand and upper extremity care at the Raleigh Hand to Shoulder Center.

Wrist Fracture Treatment Options

Wrist fracture treatment depends on the severity of the fracture on the x-rays and the patient’s health and activity level. The distal radius bone usually heals after a fracture; however, a goal of treatment is for the bone to heal in a good position for function. Many people have fractures which are in good alignment. These patients do not require surgery. Treatment in these cases is typically protection in a cast or brace for several weeks. Follow-up x-rays are obtained in clinic to see how the fracture is healing. Waterproof casts for wrist fracture treatment in Raleigh are available at the Raleigh Hand to Shoulder Center. Surgery is recommended for active patients with displaced or unstable fractures, who would benefit from restoration of the alignment.

Below is a video from the American Society for Surgery of the Hand. All physicians are board certified by the ABOS and are members of the American Society for Surgery of the Hand.

Read more about wrist fractures on our website.

Dr. Timothy Luchetti of Raleigh Hand to Shoulder Center discussed wrist arthritis at WakeMed Hand Conference on 1/16/2023.